ABSTRACT Each year, approximately 220,000 children globally are newly diagnosed with cancer. Over 85% of these new diagnoses are made in low- and middle-income countries (LMICs). Survival rates in LMICs are 5-25% compared to 80% in high-income countries (HICs). One of the primary contributors to the discrepancy in survival outcomes between LMICs and HICs is a high rate of treatment abandonment, defined as refusal to initiate or failure to complete curative treatment. Treatment abandonment rate in Tanzania is higher than in other LMICs (40% compared to 10-25%), directly impacting patient survival. In HICs, protocol-driven treatment for children with cancer has led to increased treatment compliance and large improvements in survival. However, it is often not feasible or appropriate to use protocol-driven treatment in LMICs without necessary supportive care, human resources and infrastructure. Not surprisingly, protocol-related compliance is lower in LMICs compared to HICs. Mobile technologies for health (i.e., mHealth) can facilitate implementation of and compliance with standardized pediatric oncology protocols through step-by-step decision support algorithms, reminders and alerts related to patient visits, and timely data for health service coordination with allied health providers (e.g., nurses, pharmacists etc.). This multidisciplinary team from Duke University and Dimagi Inc. in USA, and Bugando Medical Center (BMC) in Tanzania, proposes to adapt, implement, and evaluate an mHealth case management system for improving health provider compliance with standardized pediatric oncology protocols. The specific aims are to: (1) Adapt an open-source mHealth case management platform to incorporate protocol-driven treatment for pediatric cancer, and (2) Evaluate the efficacy of the mHealth case management system for supporting protocol-driven treatment for pediatric cancer and reducing treatment abandonment. A subsequent R01 study designed as a large randomized controlled trial will measure impact of the digital case management system on survival outcomes, and cost-effectiveness. Upon successful completion of the study, the case management system will be scalable to cancer centers in Tanzania and other LMICs, and inform expansion to target patient-level barriers of treatment abandonment (e.g., via health education, engagement in care between treatment visits, etc.).